实现健康中国战略2030年人均预期寿命目标路径研究

目的：从健康社会决定因素角度,评估相关因素发展对中国人均预期寿命的影响,基于因素发展路径预测中国2030年人均预期寿命,分析健康中国战略2030年人均预期寿命目标的实现路径,提出政策建议。方法：利用1990—2017年跨国面板数据,采用个体固定效应模型分析人均预期寿命与健康社会决定因素相关性,基于因素发展路径模拟（高、中、低三种方案）预测中国2030年人均预期寿命,并与战略目标值比较分析。结果：人均GDP、受教育程度、卫生人力密度等与人均预期寿命正向相关,PM2.5、交通事故死亡率、个人现金卫生支出占比与人均预期寿命负向相关。按照中方案,中国2030年人均预期寿命可达79.22岁（95% CI：78.00~80.47）,可以实现健康中国战略2030年设定的79.0岁目标。在快速发展的情景下,高方案的预测值可达81.46岁（95% CI：80.23~82.70）;在发展受阻和疫情冲击的双重负向作用下,低方案的预测值仅为76.48岁（95% CI：75.21~77.77）,甚至低于2019年77.3岁历史值。结论：在推进健康中国建设过程中,应明确制定健康责任部门考核指标,推动健康融入所有政策落地;将短期发展与中长期发展相结合,分层分阶段实现发展目标;改善区域间人均预期寿命发展的不平衡,带动人均预期寿命整体提高。     

实现健康中国战略2030年人均预期寿命目标路径研究

目的:从健康社会决定因素角度,评估相关因素发展对中国人均预期寿命的影响,基于因素发展路径预测中国2030年人均预期寿命,分析健康中国战略2030年人均预期寿命目标的实现路径,提出政策建议。方法:利用1990—2017年跨国面板数据,采用个体固定效应模型分析人均预期寿命与健康社会决定因素相关性,基于因素发展路径模拟(高、中、低三种方案)预测中国2030年人均预期寿命,并与战略目标值比较分析。结果:人均GDP、受教育程度、卫生人力密度等与人均预期寿命正向相关,PM2.5、交通事故死亡率、个人现金卫生支出占比与人均预期寿命负向相关。按照中方案,中国2030年人均预期寿命可达79.22岁(95%CI:78.00～80.47),可以实现健康中国战略2030年设定的79.0岁目标。在快速发展的情景下,高方案的预测值可达81.46岁(95%CI:80.23～82.70);在发展受阻和疫情冲击的双重负向作用下,低方案的预测值仅为76.48岁(95%CI:75.21～77.77),甚至低于2019年77.3岁历史值。结论:在推进健康中国建设过程中,应明确制定健康责任部门考核指标,推动健康融入所有政策落地;将短期发展与中长期发展相结合,分层分阶段实现发展目标;改善区域间人均预期寿命发展的不平衡,带动人均预期寿命整体提高。     

2021年我国196个城市人均预期寿命及其影响因素

目的 了解我国196个城市的人均预期寿命现况,并分析其主要影响因素,为制定和完善相关政策提供参考依据。方法 基于2021年全国健康城市评价指标数据,采用Spearman相关性分析对人均预期寿命与各指标间的相关性进行初步判断,并采用多元逐步线性回归模型分析影响人均预期寿命的主要因素。结果 2021年,我国196个城市的人均预期寿命为(79.96±2.44)岁。多元逐步线性回归分析结果显示,居民健康素养水平(Β=0.156)、国家卫生县城(乡镇)占比(Β=0.017)、人均地区生产总值(Β=0.054)、15岁以上人群吸烟率(Β=-0.066)、严重精神障碍患者规范管理率(Β=0.074)、经常参加体育锻炼人口比例(Β=0.042)、甲乙类传染病发病率(Β=-0.003)是影响人均预期寿命的主要因素(P<0.05)。结论 人均预期寿命受多方面因素影响,未来应通过提升居民健康素养,重视居民心理健康和精神卫生,加强国家卫生城镇创建和健康城镇健康细胞建设,积极应对人口老龄化等措施,提高人均预期寿命。     

我国居民2030年预期寿命预测及国际间比较

目的为满足"健康中国2030"规划编制的需要,预测我国居民2030年预期寿命水平,比较我国预期寿命在国际所处位置。方法 1.以第4、5、6次人口普查完整寿命表及联合国人口基金会预测的2030年婴儿死亡率为依据,采用指数回归方法对2030年我国居民年龄别死亡率进行预测,进而计算预期寿命。2.根据联合国人口基金会对各国的预期寿命预测,比较中国所处位置。结果 2030年我国居民人均预期寿命将达79.04岁(联合国人口司预测值为79.08岁),较2015年增长2.7岁。60岁以上老人对预期寿命增长的贡献将升至53.4%,预期寿命增长主要贡献人群向高年龄段转移。2030年,我国居民预期寿命将明显高于中等收入国家,与高收入国家间的差距进一步缩小。讨论加强对老龄人口的健康保障力度将成为保障预期寿命继续增长的关键。各项健康保障与服务公平性政策确保我国居民预期寿命与高收入国家差距不断缩小。     

我国居民2030年预期寿命预测及国际间比较

目的为满足"健康中国2030"规划编制的需要,预测我国居民2030年预期寿命水平,比较我国预期寿命在国际所处位置。方法 1.以第4、5、6次人口普查完整寿命表及联合国人口基金会预测的2030年婴儿死亡率为依据,采用指数回归方法对2030年我国居民年龄别死亡率进行预测,进而计算预期寿命。2.根据联合国人口基金会对各国的预期寿命预测,比较中国所处位置。结果 2030年我国居民人均预期寿命将达79.04岁(联合国人口司预测值为79.08岁),较2015年增长2.7岁。60岁以上老人对预期寿命增长的贡献将升至53.4%,预期寿命增长主要贡献人群向高年龄段转移。2030年,我国居民预期寿命将明显高于中等收入国家,与高收入国家间的差距进一步缩小。讨论加强对老龄人口的健康保障力度将成为保障预期寿命继续增长的关键。各项健康保障与服务公平性政策确保我国居民预期寿命与高收入国家差距不断缩小。     

中国人均预期寿命时空变化及影响因素分析

运用变异系数和灰色关联分析法,对中国人均预期寿命时空变化特征及影响因素的强度进行研究。结果表明:(1) 1981—2015年,我国人均预期寿命增长经历了慢—快—慢—快的四个阶段,预期寿命增长指数上升到113,其中男性上升到111,女性上升到115,男女预期寿命差距逐步增大。(2) 1990—2010年,全国31个省份人均预期寿命变异系数从0. 051降低到0. 036,预期寿命水平较低省份的增长速度明显高于较高的省份。(3)我国人均预期寿命的地域分布大体上分为东南部高预期寿命水平区、中北部中预期寿命水平区、西南部低预期寿命水平区。2010年我国人均预期寿命水平绝大多数省份处于第二级(76～80岁)和第三级(71～75岁),相对于1990年提高了两级。到2020年,我国将有北京、天津和上海3市处于第一级寿命水平(81～85岁),其余为第二和第三级预期寿命水平。影响我国省际人均预期寿命时空差异的因素是多方面的,其中最主要的是各地区的经济发展、医疗服务和医疗保障水平。     

中国预期寿命变动的地区差异及其社会经济影响因素:1981—2010

利用最近四期人口普查数据估算的分省预期寿命及相应年份的社会经济统计资料,分析改革开放以来不同省份人口预期寿命之间的地区差异及其历时变动情况,并通过拟合针对面板数据的随机效应模型考察影响人口预期寿命地区差异的社会经济因素。结果研究发现,中国不同地区人口预期寿命差距明显,这一差距在1990—2010年总体上经历了先升后降的变动过程。面板数据模型分析结果显示,经济发展水平和增长速度、收入不平等程度以及教育和卫生基础资源状况是导致不同地区人口预期寿命差异的重要影响因素。     

四川省居民预期寿命趋势分析和预测

目的分析四川省居民预期寿命变化趋势,预测未来5年预期寿命水平。方法收集2000-2015四川省预期寿命数据,采用Joinpoint线性回归分析年度变化趋势,并建立GM(1,1)模型进行预测。结果 2000-2015年四川省人均预期寿命呈上升趋势,且女性预期寿命始终大于男性预期寿命。Joinpoint线性回归显示,人均预期寿命、男性预期寿命和女性预期寿命的年度变化百分比分别为0.41%(95%CI:0.33~0.49)、0.41%(95%CI:0.29~0.54)、0.44%(95%CI:0.37~0.50),且变化趋势均有统计学意义。GM(1,1)模型预测四川省2020年人均预期寿命将达到77.6岁,其中男性预期寿命74.7岁,女性预期寿命81.1岁。结论未来四川省居民预期寿命将继续增加,四川省2020年人均预期寿命可以达到全国目标。     

发达国家预期寿命变化和原因及对我国的启示

预期寿命是度量人口健康状况的最重要指标,也是衡量一个国家或地区经济社会发展和医疗卫生服务水平的综合指标,并受生物学因素、环境因素、生活方式以及医疗卫生服务等因素的影响.新中国成立以来,我国人口预期寿命不断提高,由建国初期的35岁,上升至1982年的68岁,2010年的74.8岁,上海、天津、北京等经济发达地区预期寿命已超过80岁,但还有一些经济欠发达省份预期寿命尚未达到70岁.201 1年,《国民经济和社会发展第十二个五年规划纲要》提出"人均预期寿命提高1岁"的预期性指标,如何达到这一目标,如何缩小不同省份居民预期寿命的差距,是亟待我们研究的课题之一.笔者拟从流行病学范畴(探讨死亡模式的改变)和社会经济学范畴(分析死亡模式转变的根本原因)来分析日本、韩国、美国等国家预期寿命变化的历程及原因,对提高我国人均预期寿命工作有一定启示.     

漳浦县农村基层计生人员艾滋病健康教育调查

[目的]了解基层计生人员对艾滋病知识掌握情况,为今后开展健康教育提供依据。[方法]以各乡镇(场)为单位,对农村计生工作人员进行的无记名自填式问卷调查。[结果]艾滋病知晓率63.8%,没听说过艾滋病25人,占3.3%;允许艾滋病感染者继续工作学习313人(41.3%),不允许180人(23.8%);愿意与得了艾滋病的亲戚和朋友来往375人(49.5%),不愿意119人(15.7%);曾参与过有关艾滋病活动的144人(19.0%),曾参与义务献血73人(9.6%)。[结论]作为农村基层计生协会成员(比较优秀的群体),调查结果与预期仍有一定的差距,合理利用现有资源(计生、妇联和乡医网络等),开展艾滋病健康干预工作,将成为今后健康促进、干预的工作重点。     

Writing social determinants into and out of cancer control: An assessment of policy practice

A large literature concurs that social determinants of health (SDH) are demonstrable, important, and insufficiently attended to in policy and practice. A resulting priority for research should be to determine how the social determinants of health can best be addressed. In this paper we support the more effective transfer of social determinants research into policy by: (1) describing a qualitative analysis of thirty-two cancer control policy documents from six English-speaking OECD countries and two transnational organizations, demonstrating great variability in the treatment of social determinants in these policies; (2) critiquing these various policy practices in relation to their likely impact on social determinants of health; and (3) advancing a tool that policy writers can use to assess the way in which social determinants of health have been addressed in their work. In the sample of policy documents, the distinction between structural and intermediate determinants, population-based and targeted interventions, and their respective relationships to equity were not always clear. The authors identified four approaches to social determinants (acknowledging SDH, auditing SDH, stating aims regarding SDH and setting out actions on SDH), and five ways of writing about the relationship between social determinants and cancer risk. These five discourses implied, respectively: that group membership was intrinsically risky; that not enough was known about SDH; that risk arose from choices made by individuals; that groups were constrained by circumstance; or that structural change was necessary. Socio-cultural factors were generally presented negatively, though New Zealand policies modeled a possible alternative. Based on their empirical work, the authors propose a matrix and a set of questions to guide the development and assessment of health policy.     

Avoidable mortality trends in Aboriginal and non‐Aboriginal populations in the Northern Territory, 1985‐2004

Objectives: To analyse rates of avoidable mortality in Aboriginal and non‐Aboriginal residents of the Northern Territory (NT) from 1985 to 2004, in order to assess the contribution of health care to life expectancy improvements. Methods: Australian Bureau of Statistics (ABS) death registration data for NT residents were used to identify ‘avoidable’ deaths, with further separation into three categories of conditions amenable to either medical care or health policy, and a category for ischaemic heart disease (IHD). A Poisson regression model was used to calculate the average annual change in avoidable mortality by sex and Aboriginality in the NT compared with Australia as a whole. Results: In the 20 years between 1985 and 2004, avoidable mortality rates fell 18.9% in NT Aboriginal people, 61.1% in NT non‐Aboriginal people and 59.5% in Australians overall. NT Aboriginal people continued to experience higher avoidable mortality than other Australians and the disparity increased over time. Most of the decline in avoidable mortality for Aboriginal Territorians occurred for conditions amenable to medical care. Conclusion: Medical care has made a significant contribution to improvements in Aboriginal life expectancy in the NT, however, reductions in avoidable mortality from IHD and conditions amenable to health policy have been variable. Implications: The results highlight the need for ongoing investment in comprehensive programs incorporating appropriate health policy interventions and management of chronic diseases.     

Bridging the gap in life expectancy of the aborigines in Taiwan

BACKGROUND: Similar to the general population in Taiwan, the health of aborigines has steadily improved over the last 30 years, but the gap remains wide, especially in males, despite an infusion of substantial medical resources. The objectives of this study are to quantify the contribution of major causes of death to the gap in life expectancy and to propose initiatives to bridge the health gap between aborigines and the general population. METHODS: This study included residents (slightly over 200000) from 30 'aboriginal townships' in Taiwan. The gap in life expectancy between aborigines and the general population was analysed by decomposing these gaps according to major causes of deaths. This analysis quantifies the contribution of different causes of deaths to the gap in life expectancy between the two populations. RESULTS: The overall mortality of aborigines in these townships was approximately 70% higher than the respective male and female general populations over the past 30 years. Mortality from infectious disease, cirrhosis of the liver, accidents, and suicide are substantially higher than the general population. The gap in life expectancy at birth in males was 8.5 years during 1971-1973, increasing to 13.5 years by 1998-2000, however, the gap in females remained relatively stable (8.0 years and 8.4 years, respectively). Of the 13.5-year difference in life expectancy in males, the differential mortality from diseases of the digestive system (mainly due to cirrhosis of the liver), accidents (from both motor vehicle and non-motor vehicle accidents), and infectious and parasitic disease contributed half (50%) of the gap in life expectancy. In females, the above primarily preventable causes of deaths accounted for 41% of the life expectancy gap. CONCLUSIONS: Based on the findings of this study, we suggest that future focus should be in the area of primary prevention in order to reduce the incidence of infectious and parasitic diseases, liver cirrhosis, and accidents.     

确定卫生研究优先领域的分析方法进展

在资源一定的情况下，科学确定卫生研究的优先领域可以使有限的资源发挥最大的效用。目前，国际上探讨确定卫生研究优先领域常用的3种方法：卫生研究资源流向管理；疾病负担和健康影响因素分析；卫生研究中干预措施的成本效果分析。对这3种方法的意义、研究现状、存在的问题及对纠正“10：90不平衡”的作用进行了一一阐述。     

Dynamics of social health insurance development: examining the determinants of Chinese basic health insurance coverage with panel data

Social health insurance (SHI) is gaining popularity in many developing countries, but there are few systematic empirical studies on the dynamics of SHI development. This study investigates the determinants of coverage of the Basic Healthcare Insurance for Urban Employees (BHI) in China. Using a panel database ranging from 1999 to 2007, the study finds that: (1) economic development plays a valuable role in BHI development; (2) strong financial capacity and administrative capacity in the government contributes to BHI progress; (3) higher trade union density is closely related to more rapid BHI expansion; and (4) taxation agencies are better at collecting SHI premiums. These findings provide evidence-based lessons for new and ongoing SHI programs. In addition, this article aims to make a more general contribution to the study of social policy development by expanding the scope of current theories on social policy development.     

Social determinants of health and local government: understanding and uptake of ideas in two Australian states

Objective: To examine the awareness and perceptions of local government staff about the social determinants of health (SDoH) and health inequity and use of these ideas to shape policy and practice. Methods: 96 staff at 17 councils in South Australia or New South Wales responded to questions in a pilot online survey concerning: sources of knowledge about, familiarity with the evidence on, attitudes towards, and uses of ideas about the social determinants of health. Eight of 68 SA councils and 16 of 152 NSW councils were randomly selected stratified by state and metropolitan status. Differences between states and metropolitan/non‐metropolitan status were explored. Results: The majority of respondents (88.4%) reported some familiarity with ideas about the broad determinants of health and 90% agreed that the impact of policy action on health determinants should be considered in all major government policy and planning initiatives. Research articles, government/professional reports, and professional contacts were rated as important sources of knowledge about the social determinants of health. Conclusion: Resources need to be dedicated to systematic research on practical implementation of interventions on social determinants of health inequities and towards providing staff with more practical information about interventions and tools to evaluate those interventions. Implications: The findings suggest there is support for action addressing the social determinants of health in local government. The findings extend similar research regarding SDoH and government in NZ and Canada to Australian local government.     

Conceptions and uses of public health ideas by New Zealand government policymakers: report on a five-agency survey

OBJECTIVES: This article describes New Zealand government policymakers' awareness of, attitudes toward and self-reported use of ideas about the determinants of health. Some comparison with an earlier Canadian study is provided. METHODS: Employees with policymaking and advisory responsibilities in government departments of health, social development, housing, education and finance were surveyed. RESULTS: More than half of the respondents (58%) were familiar with ideas about health determinants. Eighty percent felt that health determinants should be considered in all government policy, but that more practical information on effective policy interventions is needed. Commitment to the idea that the economy should take precedence over reducing health inequalities was low. CONCLUSIONS: There is a demand for literature on health determinants that is sector specific and which provides practical and proven information about effective interventions that influence health.     

The contribution of medical care to changing life expectancy in Germany and Poland

This paper assesses the impact of medical care on changes in mortality in east Germany and Poland before and after the political transition, with west Germany included for comparison. Building upon Rutstein's concept of unnecessary untimely deaths, we calculated the contribution of conditions considered responsive to medical care or health policy to changes in life expectancy between birth and age 75 [e(0-75)] for the periods 1980/1983-1988 and 1991/1992-1996/1997.Temporary life expectancy, between birth and age 75, has been consistently higher in west Germany, intermediate in east Germany and lowest in Poland. Although improving in all three regions between the early 1980s and the late 1990s, the pace of change differed between countries, resulting in a temporary widening of an initial east-west gap by the late 1980s and early 1990s. In the 1980s, in east Germany, 50-60% of the improvement was attributable to declining mortality from conditions responsive to medical care (west Germany: 30-40%). A net positive effect was also observed in Poland, although counterbalanced by deterioration in ischaemic heart disease mortality.In the former communist countries, improvements attributable to medical care in the 1980s were due, largely, to declining infant mortality. In the 1990s, they benefited also adults, specifically those aged 35+ in Poland and 55+ in Germany. A persisting east-west gap in temporary life expectancy in Germany was due, largely, to higher mortality from avoidable conditions in the east, with causes responsive to health policy contributing about half, and medical care 16% (men) to 24% (women) to the differential in 1997.The findings indicate that changes in the health care system related to the political transition were associated with improvements in life expectancy in east Germany and, to a lesser extent, in Poland. Also, differences in the quality of medical care as assessed by the concept of "unnecessary untimely deaths" appear to contribute to a persisting east-west health gap. Especially in Poland and the former German Democratic Republic there remains potential for further progress that would narrow the health gap with the west.     

Crisis económico-financiera y salud en España. Evidencia y perspectivas. Informe SESPAS 2014

The objectives of the SESPAS 2014 Report are as follows: a) to analyze the impact of the economic crisis on health and health-related behaviors, on health inequalities, and on the determinants of health in Spain; b) to describe the changes in the Spanish health system following measures to address the crisis and assess its potential impact on health; c) to review the evidence on the health impact of economic crises in other countries, as well as policy responses; and d) to suggest policy interventions alternative to those carried out to date with a population health perspective and scientific evidence in order to help mitigate the impact of the economic downturn on health and health inequalities. The report is organized in five sections: 1) the economic, financial and health crisis: causes, consequences, and contexts; 2) the impact on structural determinants of health and health inequalities; 3) the impact on health and health-related behaviors, and indicators for monitoring; 4) the impact on health systems; and 5) the impact on specific populations: children, seniors, and immigrants. There is some evidence on the relationship between the crisis and the health of the Spanish population, health inequalities, some changes in lifestyle, and variations in access to health services. The crisis has impacted many structural determinants of health, particularly among the most vulnerable population groups. Generally, policy responses on how to manage the crisis have not taken the evidence into account. The crisis may contribute to making public policy vulnerable to corporate action, thus jeopardizing the implementation of healthy policies.     

我国老龄健康公平社会决定因素分析及对策

我国人口健康水平不断提升的同时老龄健康公平差距客观存在,而影响健康公平的社会决定因素又处于动态变化之中。本文依据WHO健康社会决定因素理论框架对我国老龄健康公平社会决定因素进行分析,提出了除以往影响老龄健康公平的共识性社会决定因素外,还包括宏观层面的老龄健康政策、老龄人口流动、科技发展和死亡认知等,个体层面的退休后工作及社会参与等,日常生活环境层面卫生服务体系的老龄友善程度,如老年卫生资源配置公平性、老年人对相关服务的可获得性及利用公平以及重大公共卫生事件对老龄健康公平的冲击等;并针对性提出要进一步加强对老龄健康公平的认识与评估,多措并举、多种公平兼顾缩小老龄健康公平差距,助力实现健康老龄化。